Immediate provisional implant

ABSTRACT

An immediate provisional implant is provided, and method of use therefor, that serves to protect permanent dental implant anchors and overlying tissue during the healing and osseointegration process. Potentially damaging forces resulting from patient use of a temporary prosthesis during the osseointegration period are carried by the immediate provisional implant, rather than impinging upon non-osseointegrated permanent implant anchors or overlying tissue. The immediate provisional implants are self-threading and are inserted in osteotomies located near permanent dental implant anchors. The temporary prosthesis is removed after a period allowed for osseointegration of the permanent implant anchors, and the provisional implants can also be removed at the same time. The immediate provisional implants are non-linearly tapered from a maximum thread diameter near the bone surface to a more narrow distal end, providing immediate stability without the benefit of osseointegration.

REFERENCE TO RELATED APPLICATION

This application claims the priority benefit under 35 U.S.C. §119(e)from provisional Application No. 60/149,642, filed Aug. 17, 1999.

FIELD OF THE INVENTION

The present invention relates generally to dental implants and, moreparticularly, to an immediate provisional implant that allows forfitting a fixed, provisional prosthesis after first stage surgery.

BACKGROUND OF THE INVENTION

Dental implants are placed in the jaw to provide support for a dentalrestoration, fixed bridge or removable partial denture. Dental implantsprovide good chewing function and also improve the patient's cosmeticappearance, thereby allowing the patient to smile, speak, and interactwith others with greater confidence.

One type of dental implant widely used in the industry is a “threaded”implant. Threaded implants have an externally threaded body segment,which is screwed into a pre-drilled hole (i.e., an osteotomy), in thepatient's upper or lower jawbone. Typically, the threaded implant bodyis formed with a central threaded socket accessible through theoverlying gum tissue for receiving and supporting one or more dentalattachments or components. Types of attachments and components that arereceived by the central socket include healing caps, impression copingsand abutments. In turn, some of these attachments and components areuseful to fabricate and/or to support a prosthodontic restoration, fixedbridge or partial denture. Exemplary implant constructions are disclosedin U.S. Pat. No. 4,645,453 to Nizick, U.S. Pat. No. 5,074,790 to Bauerand U.S. Pat. No. 5,312,255 to Bauer.

Dental implants are typically packaged as an assembly including all thetools necessary for the insertion of the implant into an osteotomyformed in the jaw. A typical threaded implant assembly includes athreaded implant body, an implant carrier, an insertion post, a couplingscrew and a healing cap. The implant carrier, insertion post, andcoupling screw are tools which are used for the insertion of the implantbody. Typically, the implant carrier, insertion post and coupling screware discarded after the implant body has been inserted into theosteotomy.

During the insertion procedure, the insertion post is securely coupledto the top of the implant body. The insertion post is held in place by acoupling screw, which traverses a central through-cavity in theinsertion post and is threaded into the central threaded socket in theimplant body. Typically, the bottom end of the insertion post has ahexagonal cavity that irrotationally mates with a hexagonal protrusionon the top of the implant, thereby preventing any relative rotationbetween the insertion post and implant body.

The coupling screw and insertion post are releasably coupled to animplant carrier. The implant carrier provides the dental practitionerwith a means to grip and manipulate the assembly during the initialimplantation procedure. Typically, the implant carrier includes agenerally hexagonal internal passage at its bottom end which mates witha generally hexagonal outer surface of the insertion post. This allowstorque applied to the carrier to be transferred, via the insertion post,to the threaded implant body. The dental practitioner uses the implantcarrier to manipulate the implant body into the proper location withinthe jaw.

In use, the first step of the implantation procedure usually involvesmaking an incision in the patient's gum. A portion of the gum is thenfolded back and an osteotomy is drilled in the jawbone. The diameter ofthe osteotomy is equal to or slightly smaller than the diameter of theimplant body. The implant carrier is then used to transport the threadedimplant assembly to the surgical site. The implant carrier is used bythe practitioner to manipulate the implant body into the correctposition and then to partially screw the implant body into theosteotomy. Once the implant body has been initially placed in theosteotomy and tightened manually, the carrier is then pulled and/orloosened and removed from the dental implant assembly, leaving only theinsertion post and coupling screw in engagement with the threadedimplant body. A suitable wrench or dental hand piece is then used toengage the insertion post and drive the implant to its final depthwithin the osteotomy. The coupling screw is then unscrewed from theimplant body, thereby allowing extraction of the insertion post andcoupling screw from the patient's mouth. Next, a healing cap is screwedinto the exposed socket of the implant to cover the implant socket. Thehealing cap protects the implant socket against tissue in-growth duringthe initial healing period, and also prevents the entry of bacteria orother contaminants into the exposed central socket of the implant.Typically, the healing cap is housed in a cavity at the top of theimplant carrier and is secured with a paper barrier until needed.

The insertion of the implant body and healing cap is followed by aninitial healing period in which the bone is allowed to surround andretain the implant (i.e., “osseointegrate” with the implant) and the gumtissue is allowed to heal over the implant body and healing cap. Forimplants placed in the mandible, healing typically requires about threemonths; for implants in the maxilla, the healing period typicallyrequires about six months.

After sufficient osseointegration has occurred, the gum tissue isre-opened by making an incision and the gum tissue is once again foldedback to remove the healing cap from the implant body. To remove thehealing cap from the implant body, torque is applied to the healing capto rotate the healing cap out of the implant socket. Typically, aremoval tool with a hexagonal tip is inserted into a correspondingmating hexagonal recess located in the top center of the healing cap.Great care must be used to rotate the healing cap without also rotatingthe implant body. Any movement of the implant body relative to theosteotomy during the removal of the healing cap could damage theosseointegration between the implant body and the jawbone. Damage to theosseointegration is very undesirable and could endanger the entiredental restoration process by destabilizing the implant. In addition,any movement of the implant body could create unwanted gaps or spacesbetween the implant body and jawbone which could lead to infection bybacteria or other contaminants. After the healing cap has been unscrewedand removed from the implant body, a suitable healing abutment isattached. The healing abutment extends through the gum tissue overlyingthe implant site.

A second healing period then ensues in which the gum tissue is allowedto heal around the post-osseointegration healing abutment. Typically,this second healing period lasts from four to eight weeks. After thissecond healing period, the healing abutment is removed from the implant.Typically, an impression is taken of the patient's mouth to fabricate aprosthesis or dental restoration. An abutment supporting the finalrestoration is attached to the implant. Lastly, the restoration iscemented or screwed to the abutment and/or implant to complete theplacement of the prosthodontic restoration in the patient's mouth.

The threaded dental implants described above, as well as other dentalimplants, such as “cylindrical” implants, require healing periods ofthree to six months or more. In the meantime, it has been desirable inthe past to provide patients with temporary partial dentures or fulldentures until the final restoration is in place. However, masticationforces on conventional temporary partial dentures and full dentures canharm or otherwise irritate the gum tissues overlying conventionalsubmerged implants, bone grafts or tissue grafts and/or can also disturbthe implants.

Accordingly, methods and structures are needed to provide protection tosubcutaneous implants and the adjacent tissues from impingingmastication forces and moments during the healing period.

SUMMARY OF THE INVENTION

Briefly stated, the aforementioned needs are satisfied by a new methodof providing permanent dental prosthesis that utilizes one or moreimmediate provisional implants to support a temporary prosthesis duringthe healing phase after conventional endosseous implant surgery. Inparticular, the immediate provisional implant(s) are positioned betweenconventional permanent implants, and are used to support temporarydental prostheses while the permanent implants are allowed toosseointegrate. Desirably, the immediate provisional implants arestructured to satisfy the particular needs of this temporary support.

The immediate provisional implant (IPI) system of the present inventionis advantageously designed to allow implant surgeons to place titaniumalloy provisional implants in either the mandible or maxilla. Implanttherapy often requires the patient to wear a provisional restoration foran extended period of time during the healing phase. An importantadvantage of the IPI System is to be able to deliver a more stable,temporary fixed prosthesis at the time of implant placement. Thisprosthesis removes the load from the soft tissues overlying subcutaneousimplants surgically placed simultaneously or at about the same time(i.e., immediately prior or subsequent to implanting the immediateprovisional implants) at adjacent sites during stage-one surgery.

By carrying the load of the temporary prostheses, the provisionalimplants allow improved healing of the permanent implant sites and atthe same time provide the patient an aesthetic, functional, fixedprovisional prosthesis after stage-one surgery. This is especiallyimportant for grafted sites. Placement of provisional implants enablesthe patient to wear an aesthetic, stable, fixed provisional prosthesis.This can improve treatment acceptance of grafting and implantprocedures. Such use of provisional implant dental restorations alsominimizes the risk of possible bone atrophy and bone shifting caused byreduced bone loading during the healing period.

The diameter of each provisional implant is preferably narrow enough toallow it to be placed between permanent implants at the time of surgery.The immediate provisional implant width or diameter is preferablybetween about 1 mm and 3.5 mm, more preferably less than about 3 mm, andin the illustrated embodiments the implants have a maximum outer threaddiameter between about 2 mm and 2.8 mm (preferably tapered along itslength). A non-linear taper is preferred in another embodiment, wherebythe thread diameter rapidly increases near the top of the threadedsegment adjacent the crestal bone. Advantageously, this allows thatregion of the threaded body which is mated with the denser cortical boneto resist applied moments, with less damage to the less dense bonebeneath. The non-linear tapered implant may be generally characterizedas having a flared upper segment having a relatively large taper angle,a generally cylindrical intermediate segment and a lower tapered segmenthaving a relatively small taper angle.

The overall length of the preferred immediate provisional implant ispreferably greater than about 17 mm, more preferably greater than about20 mm, and most preferably about 22 mm. This length includes an anchorsegment designed to be anchored in cortical bone to a depth greater thanthat of adjacent permanent implants. This anchor segment is threaded inthe illustrated embodiments, and is preferably 12-16 mm (14 mmpreferred), sufficient to support the forces on a provisionalprosthesis. A flared taper at the proximal end of the implantfacilitates enhanced engagement of the cortical bone layer, giving theimmediate provisional implant according to the invention better initialstability without osseointegration. This allows the underlyingconventional implant or graft to heal without premature loading.

One preferred embodiment of a provisional implant according to theinvention also preferably includes an integral extension from theanchoring segment, preferably greater than about 3 mm, more preferablygreater than about 5 mm, and most preferably about 7.34 mm. Theextension includes a portion extending above the crestal bone andserving to receive a temporary dental prosthesis or restoration.

The immediate provisional implant is preferably of single piececonstruction and is preferably fabricated from titanium alloy forstrength. The extension from the anchoring segment preferably includesan abutment portion and an intermediate bendable neck to allow forabutment parallelism. The hourglass shape of such a neck not onlyprovides the desired flexibility, but can also help prevent migration ofsoft tissue over the implant abutment.

The integral implant and abutment design provides predictable retentionand support of the temporary prosthesis. Machined titanium copings,which become integrated into the final prosthesis, engage the tapereddesign of the abutment resulting in retention, stability and a precisemargin fit of the temporary restoration. The provisional restoration maybe fabricated by the restorative dentist or clinician directly over thetitanium coping. Optional analogs are also preferably available if it ispreferred or indicated to fabricate the restoration using a laboratorymodel and a cast stone replica of the patient's mouth/jaw.

Advantageously, the IPI System can be used for fully and partiallyedentulous patients. Two to three immediate provisional implants can beused for a partially edentulous patient. On average, a fully edentulouscase employs four-to-six immediate provisional implants (preferably,five in the maxilla). The immediate provisional implants are preferablyplaced at a minimum distance of about 3.0 mm from conventional submergedroot form implants. The IPI System thus eliminates the need fortemporary partial dentures that can otherwise harm or irritateconventional submerged implants or bone grafts. Once the permanentimplants are fully healed and osseointegrated to the patient's jaw bone,the immediate provisional implants can be partially or fully removedwith minimal discomfort to the patient. Patient acceptance forconventional implant procedures may increase due to the fact that theimmediate provisional implant system allows them to leave the officeafter stage-one implant surgery with a fixed provisional or temporaryrestoration.

In accordance with one aspect of the invention, a method of providingpermanent dental prosthesis to a patient who is at least partiallyedentulous includes providing a permanent implant within bone in apatient's mouth at a permanent implant site, and providing a provisionalimplant within the bone in the patient's mouth adjacent the permanentimplant site.

In accordance with another aspect, a method provides a fixed, temporarydental prosthesis during a healing period for permanent implantosseointegration. The method includes implanting permanent implants in abone within a patient's mouth. Provisional implants are also implantedin the bone at positions alternatingly adjacent the permanent implants.Each of the provisional implants includes an abutment protruding out ofthe bone. The temporary dental prosthesis is adhered to the abutments.After a healing period, during which the permanent implantsosseointegrates, the temporary dental prosthesis is removed from theabutments.

In accordance with another aspect of the invention, a system provides aninterim dental prosthesis while allowing osseointegration of a permanentimplant. The system includes at least one permanent implant foranchoring within a patient's mouth. The system also includes a pluralityof provisional implants for anchoring adjacent the permanent implant. Atemporary dental prosthesis is configured to be supported upon theprovisional implants.

In accordance with another aspect of the invention, a system provides animmediate provisional dental implant. The system includes a plurality ofprovisional dental implants. The implants each include a threaded bodysegment, a neck segment integrally formed with and extending from thebody segment, and an abutment integrally formed with and extending fromthe neck segment. The body segment preferably has a maximum width nomore than about 3.5 mm. The neck segment includes a torque acceptingfeature. The system also includes an osteotomy drill with a diameterless than the maximum width of the threaded body. A torque-supplyingdriver tool is adapted to engage with the torque-accepting feature ofeach provisional dental implant in order to impart rotation forself-screwing the provisional implant into an osteotomy drilled by theosteotomy drill.

In accordance with another aspect of the invention, an integrally-formedimmediate provisional dental implant extends along an implant axis. Theimplant includes an abutment adapted to bond with a dental prosthesis, aflexible neck segment connected to the abutment, and a threaded bodysegment. The body segment has threads extending helically about theimplant axis. The thread diameter tapers non-linearly from a maximumadjacent the neck segment to a minimum at a distal end. For purposes ofsummarizing the invention and the advantages achieved over the priorart, certain objects and advantages of the invention have been describedherein above.

Of course, it is to be understood that not necessarily all such objectsor advantages may be achieved in accordance with any particularembodiment of the invention. Thus, for example, those skilled in the artwill recognize that the invention may be embodied or carried out in amanner that achieves or optimizes one advantage or group of advantagesas taught herein without necessarily achieving other objects oradvantages as may be taught or suggested herein.

All of these embodiments are intended to be within the scope of theinvention herein disclosed. These and other embodiments of the presentinvention will become readily apparent to those skilled in the art fromthe following detailed description of the preferred embodiments havingreference to the attached figures, the invention not being limited toany particular preferred embodiment(s) disclosed.

BRIEF DESCRIPTION OF THE DRAWINGS

Having thus summarized the general nature of the invention and itsessential features and advantages, certain preferred embodiments andmodifications thereof will become apparent to those skilled in the artfrom the detailed description herein having reference to the figuresthat follow, of which:

FIG. 1 is a side view of an immediate provisional implant havingfeatures in accordance with one embodiment of the present invention;

FIGS. 2A-2D are scale side and sectional views, showing one embodimentof the immediate provisional implant of FIG. 1, particularly suited forcortical engagement;

FIGS. 2E-2G are scale side and sectional views, showing anotherembodiment of an immediate provisional implant having features inaccordance with the present invention;

FIG. 3 is a perspective view of the immediate provisional implant ofFIG. 1 implanted into a patient's mandible;

FIG. 4 is a perspective view of a coping having features according toone embodiment of the present invention;

FIG. 5 is a perspective view of a plurality of immediate provisionalimplants implanted into a patient's mandible;

FIG. 6 is a perspective view of an immediate provisional implant systemhaving features according to one embodiment of the present invention;

FIG. 7 is a detail side view of the preferred components comprising theimmediate provisional implant system of FIG. 6;

FIGS. 8A-8E illustrate initial steps for implanting immediateprovisional implants in accordance with the preferred embodiments;

FIGS. 9A-9E illustrate further steps for providing temporary fixedprostheses over the immediate provisional implants of FIG. 8E, inaccordance with a direct technique embodiment for fully edentulouspatients;

FIG. 10 illustrates a further step for providing temporary fixedprostheses over the immediate provisional implants of FIG. 9C, inaccordance with another direct technique embodiment for fully edentulouspatients; and

FIGS. 11A-11C illustrate further steps for providing temporary fixedprostheses over the immediate provisional implants of FIG. 9C, inaccordance with an indirect procedure for fully or partially edentulouspatients.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

FIGS. 1 and 2A illustrate an immediate provisional implant 10 havingfeatures according to one preferred embodiment of the present invention.As shown in FIG. 2A, the implant 10 is preferably divided into fourintegral segments: a body segment 12, a neck segment 14, and a topsegment or abutment 16. In the illustrated embodiment, the neck segment14 includes a torque-accepting segment 18, particularly designed toengage with a torque-imparting tool. The body segment 12 includesmechanical structures to aid in anchoring the implant 10 within themandible or maxilla, and is preferably threaded for this purpose. Thebody segment 12 thus represents the portion of the implant that isplaced in either the mandible (see FIG. 3) or the maxilla. In theillustrated embodiment, the threading 60 extends in a helical path alongthe length of the body segment 12. The threads are preferably machinedto have a thread interval or “pitch” of about 1 mm to 1.5 mm (1.17 mmillustrated) near the top of the body segment 12, varying to about 0.6mm to 0.9 mm (0.84 mm illustrated) at the lower end on the body segment.The threads 60 have flat top lands with a nominal width of about 0.10 mmto 0.15 mm near the top of the body segment 12.

In the particular preferred embodiment of FIGS. 2A-2D, the body segment12 has three sections or sub-regions 61, 62, and 63, distinguishedaccording to how the thread diameter and depth varies in thosesub-regions. The intermediate sub-region 62 is preferably a region ofapproximately constant thread diameter of about 1.8 mm to 2.2 mm (about2.032 mm in the illustrated embodiment) and approximately constantthread depth of about 0.22 mm to 0.28 mm (about 0.254 mm in theillustrated embodiment). The lower sub-region 63, best seen from FIG.2B, preferably extends to the distal most end of the body segment 12.The lower sub-region 63 is preferably characterized by a reducing threaddiameter and thread depth toward the distal end, producing a slope orangle to the implant axis. Preferably, the thread top lands produce aslope of about 1°-10°, more preferably 3°-7° (about 5° in theillustrated embodiment). The troughs define a smaller slope, preferably0.5°-3° (about 2° in the illustrated embodiment), such that the threaddepth becomes shallower toward the distal end.

The upper sub-region 61 of the illustrated embodiment is preferablydesigned to engage the cortical bone, and is shown in more detail inFIG. 2D. The thread diameter and thread depth preferably tapers from theproximal to distal end in the upper sub-region 61 greater than thetapering in the lower sub-region 63. Preferably, this taper in threaddiameter is characterized by a slope relative to the implant axis ofabout 6°-14°, more preferably about 8°-12° and, most preferably, about10° as in the illustrated embodiment. The maximum thread diameter ispreferably less than about 3.5 mm, more preferably less than about 3 mm(2.72 mm in the embodiment of FIG. 2D). The proximal thread 64, adjacentthe top segment 16, also represents the maximum width of the immediateprovisional implant 10. The maximum thread depth, also occurringadjacent the neck segment 14, is preferably between about 0.5 mm and 0.7mm (0.6 mm in the illustrated embodiment).

Alternatively, FIGS. 2E-2G illustrate another preferred embodiment of animmediate provisional implant 10 a having an extended substantiallyconstant-diameter or cylindrical section 62 a, without the flared upperregion previously described. For convenience of description and ease ofunderstanding like reference numerals are used to designate likeelements. In accordance with this embodiment, the maximum threaddiameter is less than about 2.5 mm, and is about 2 mm in the illustratedembodiment. The second embodiment is otherwise substantially similar tothe provisional implant of FIGS. 2A-2D.

Referring again to FIG. 2A, the torque-accepting segment 18 is locatedin the lower region of the neck segment 14, shown located about 1 mmfrom the largest thread 64. The torque-accepting segment 18 ispreferably located below the top segment 16. Accordingly, thetorque-accepting segment 18 facilitates removal of the immediateprovisional implant. In the illustrated embodiments, thetorque-accepting segment 18 is faceted and takes the shape of a square(see FIGS. 2C and 2G) with truncated corners, with a thickness betweenopposite faces of the square of about 2 mm.

The remainder of the neck segment 14 is preferably bendable to adjustthe angle of the top segment or abutment 16. In the illustratedembodiment, the neck segment 14 has an hourglass shape and isillustrated with a length of 2.51 mm and a minimum width or diameter of1.27 mm. The top segment 16 is preferably 3.81 mm long, and tapered byabout 5°, with a maximum diameter of 2.36 mm at the distal end of topsegment 16, adjacent the neck segment 14. Grooves 20 preferably extendpartially around the top segment 16, except for a smooth flat surface22, best seen in FIG. 1. The smooth surface 22 is preferablycharacterized by a flat plane or face intersecting and truncating theouter surface of the otherwise conical shape of the top segment 16, withthe plane being 0.28 mm below the outer radius of the surface. This flatsurface 22 provides for engagement with a wrench and also providesanti-rotation relative to a provisional abutment or restoration securedthereto.

Unlike the permanent implants, which are meant to be submerged belowsutured soft tissue during a healing period after stage-one surgery, theneck segment 14 and abutment segment 16 are integrally formed with theanchoring or body segment 12. As noted above, these segments form anextension with a length preferably greater than about 3 mm, morepreferably greater than about 5 mm (7.34 mm in the illustratedembodiment). This integral extension serves to allow attachment of atemporary prosthesis to the provisional implants 10 without furthersteps for connecting the extension.

FIG. 3 illustrates a mandible 23 of a patient having a plurality ofimmediate provisional implants 10 implanted therein, along with aplurality of “permanent” threaded implants 24. As shown, the provisionalimplants 10 are alternated with the permanent implants 24, which aremeant to remain in place when the provisional implants are removed afterthe healing period. The provisional implants 10 are preferablysubstantially more narrow than the permanent implants 24, preferablyless than half the width.

Each provisional implant 10 is shown with a coping 26 that mates withthe top segment 16 of the implant 10. The coping 26 is also illustratedindividually in FIGS. 4A-4C.

FIG. 5 illustrates another arrangement for the immediate provisionalimplants 10. It will be appreciated that other arrangements arecontemplated, as would be determined based on the positioning of theimplants 24 and other factors.

FIGS. 6 and 7 illustrate one embodiment of the immediate provisionalimplant system. FIG. 6 shows an autoclavable kit 100 containing thetools for placement and removal of the immediate provisional implants.FIG. 7 shows the contents of the kit 100 in more detail. As shown inFIG. 7, the system includes the following: fifteen implants 10 andcopings 26 (in three packs of five); optional analogs 28 and comfortcaps 29 (also packaged in packs of five); a disposable twist drill 30;an insertion wrench 32; a hand wrench 34; a ratchet adapter 36; aratchet 38; parallel pins 40; a bending tool 42; a retrieval tool 44; astabilizer 45; and an organizer 46 for the packaged items. The packageditems 10, 26, 29 and the disposable twist drill 30 are desirablypre-sterilized. The torque-accepting segment 18 of the immediateprovisional implant of FIGS. 1-2D is designed to mate with atorque-supplying tool like the insertion wrench 32 and/or hand wrench 34that are shown in FIG. 7.

FIGS. 8A-8E illustrate a preferred placement procedure for the immediateprovisional implant system, using the components described above. Instep 1, as shown in FIG. 8A, it is first ensured that there is a minimumdistance of 3 mm from the conventionally submerged permanent implants24. Then, the cortical crestal bone 50 is penetrated preferably with adisposable twist drill 30 and the ratchet having a width smaller thanthe provisional implants 10 (1.5 mm shown). The drill 30 penetratespreferably to a depth of about 14 mm. Either the apical, buccal orlingual cortical bone is engaged to ensure implant stability.

For step 2, as shown in FIG. 8B, the insertion wrench 32 is insertedinto the hand wrench or handpiece 34. For step 3, the implant abutment16 is placed into the insertion wrench 32 and the implant 10 is selfthreaded into the osteotomy until the shoulder of the implant 10 is evenwith the ridge, as shown in FIG. 8C. If the bone 50 is dense, theratchet 38 with ratchet adapter 36 can be optionally employed. As shownin FIG. 8D, the ratchet adapter 36 is first inserted into the ratchet38. The insertion wrench 32 is placed into the ratchet adapter 36 andstep 3 proceeds as described above. For step 5, as shown in FIG. 8E,after the immediate provisional implants 10 are placed, the tissue issutured, leaving the abutment segments 16 exposed.

For the fully edentulous case, as illustrated in FIGS. 9A-9D, the fivesteps described above are followed by placing parallel pins 40 (step 6)onto the implants 10, as shown in FIG. 9A. This helps aid in visualizingorientation or parallelism of each immediate provisional implant withrespect to the jawbone or other implants. As shown in FIG. 9B (step 7),the implants are preferably adjusted or bent at the neck of the implantusing a bending tool 42 to achieve a desired orientation.

As shown in FIG. 9C (step 8), copings 26 are then placed over theimplants. In step 9 (not shown), any exposed undercuts on the implantare blocked out. The soft tissue and sutures are lubricated withpetroleum jelly. As shown in FIG. 9D, in step 10, autopolymerizing,tooth-colored acrylic, mixed to a pliable consistency, is placed into aprocessed acrylic shell 52 and placed over the copings 26. Desirably,the acrylic is moderately viscous so as to avoid being forced under thetissue onto the implant 10, hardening preferably only over the coping26. The patient is instructed to close in centric relation occlusion. Aprosthesis 54 is thereby formed, as shown in FIG. 9E.

As shown in FIG. 9E, after the acrylic has hardened, the provisionalprosthesis 54 is removed with the copings 26 secured in the prosthesis(step 11). If desired, excess acrylic can be removed from the prosthesisand the underside checked and cleared of any soft tissue impingements.The occlusion may also need to be refined and the provisionalrestoration removed, shaped and polished prior to affixation. Oncesuitably refined the restoration or provisional prosthesis 54 ispreferably cemented into place using a suitable temporary adhesive, suchas ImProv™ Temporary Cement (Cat. No. 4400) available from Nobel BiocareUSA, Inc. of Yorba Linda, Calif.

In another embodiment, a direct technique is provided using a patient'sexisting denture 56. Steps 1 to 9 are completed as described above withrespect to FIGS. 8A-9C. Then, in step 10 a (not shown), flanges areremoved from the patient's existing denture. The denture 50 is hollowedfrom second pre-molar to second pre-molar. In step 11 a,autopolymerizing acrylic is placed in the hollowed out denture 56 andplaced over the copings 26, as shown in FIG. 10. The patient isinstructed to close in centric relation occlusion. After the materialhas set, the denture is removed and cleaned, trimming excess material,and polishing the denture and removing any soft tissue impingements. Thedenture 56 is then cemented in place using a temporary cement.

In another embodiment, an indirect procedure is provided for partiallyor fully edentulous cases. Steps 1 to 9 are first completed as describedabove. The copings 26 are placed onto the implants in step 10 b, asshown in FIG. 11A. In step 11 b, an impression is taken with a resilientimpression material 58, as shown in FIG. 11B. A light body material isused at the implant/tissue interface. The impression 58 with copings 26(FIG. 11A) is then removed. A bite registration is recorded and animpression of the opposing arch is taken. In step 13 b, as shown in FIG.11C, the immediate provisional implant analogs 28 are placed into thecopings 26 and the impression is then poured in hard stone. The model isseparated from the impression and mounted on an articulator. Thetechnician can now fabricate the provisional prosthesis on the mountedmodels. After it is completed the provisional prosthesis is cemented inplace over the coping 26 using a temporary adhesive.

In each of the above embodiments, it is preferred that the provisionalrestorations be reinforced with reinforcement fibers or orthodonticwire, as appropriate.

The immediate provisional implants described above are intended toprovide interim support for a multiple unit restoration for a period ofseveral months. Typically, they will be used while permanent implantsthat have been simultaneously placed are submerged out of functionduring a period of osseointegration ranging from 3 to 6 months. Theimmediate provisional implants bear the load of temporary prosthesesduring this healing period while the permanent implants osseointegrate.

Though not necessary, the provisional implants are preferably removed atthe time of or prior to the restoration of the permanent implants.Initially, the provisional prosthesis is removed from the implants. Anyremaining temporary cement is removed from the top of the implants. Theprovisional implant retrieval tool is desirably placed into the ratchetadapter and ratchet. The retrieval tool is placed over the abutment ofthe provisional implant and the implant unscrewed by applying torque ina counter clockwise direction (for the illustrated thread orientation).After the implant is removed, a curette may be used to remove anyassociated granulation tissue. The soft tissue opening can be expectedto close similar to a tooth extraction site. Alternatively, theprovisional implants can be left in place and allowed to fullyosseointegrate to the bone. In that case, only the portion of theprovisional implants above the crestal bone are removed using a diamondburr. The exposed portions of the implant are then ground smooth withthe crestal bone and the gums are sutured over the wound and allowed toheal.

While the components of the present invention have been described with acertain degree of particularity, it is manifest that many changes may bemade in the specific designs, constructions and methodology hereinabovedescribed without departing from the spirit and scope of thisdisclosure. It should be understood that the invention is not limited tothe embodiments set forth herein for purposes of exemplification, but isto be defined only by a fair reading of the appended claims, includingthe full range of equivalency to which each element thereof is entitled.

I claim:
 1. A restorative dental method for treating a partially orfully edentulous patient, comprising the following steps: providing oneor more permanent implants extending through the crestal bone of apatient's mouth at one or more permanent implant sites for supportingone or more final dental restorations; and providing one or moreprovisional implants extending through the crestal bone in the patient'smouth adjacent the permanent implant sites for supporting one or moreprovisional dental restorations, each of the one or more provisionalimplants including a threaded segment; drilling an osteotomy adjacentthe permanent implant site; twisting the provisional implant into theosteotomy; bending a segment of the provisional implant adjacent thethreaded segment; and whereby one or more provisional dentalrestorations may be supported by the provisional implants during aninitial healing period while substantially avoiding forces being exertedon said permanent implants.
 2. The method of claim 1, furthercomprising: bearing a temporary prosthesis upon at least one of theprovisional implants; allowing the permanent implants to osseointegrate;removing the temporary prosthesis; and bearing a permanent prosthesisupon at least one of the permanent implants.
 3. The method of claim 2,further comprising removing the provisional implants prior to bearingthe permanent prosthesis.
 4. The method of claim 2, wherein bearing theprovisional implant comprises receiving forces acting on the provisionalprosthesis while the permanent implant osseointegrates.
 5. The method ofclaim 2, further comprising, after providing the provisional implant andprior to bearing the temporary prosthesis, temporarily attaching anextender to the provisional implant in order to better display itsorientation.
 6. The method of claim 1, further comprising removing theprovisional implant after a period during which the permanent implantosseointegrates.
 7. The method of claim 1, wherein twisting comprisesengaging with a torque providing tool a portion of the provisionalimplant between a threaded segment and an opposite end.
 8. The method ofclaim 1, wherein bending is performed after the provisional implant hasbeen placed in the osteotomy.
 9. The method of claim 1, whereinproviding the provisional implant is performed after providing thepermanent implant.
 10. The method of claim 1, wherein the provisionalimplant has a maximum width of less than about 3.5 mm.
 11. The method ofclaim 10, wherein the provisional implant is provided at a provisionalimplant site at least about 3 mm from the permanent implant site. 12.The method of claim 1, wherein said provisional prosthesis is attachedto the immediate provisional implants using a temporary adhesive. 13.The method of claim 1, further comprising creating a temporary dentalprosthesis for engagement with the provisional implant.
 14. The methodof claim 13, wherein creating the temporary dental prosthesis comprisesadapting an existing denture to be attached to engage the provisionalimplant.
 15. The method of claim 13, wherein said creating comprises thesteps of approximately shaping an autopolymerizing, tooth-coloredacrylic within the patient's mouth after providing the provisionalimplant and further refining this acrylic before temporarily attachingthe prosthesis to the provisional implant.
 16. The method of claim 13,further comprising closing a patient's gum over the permanent implantprior to temporarily attaching the prosthesis to the provisionalimplant.
 17. The method of claim 13, wherein said creating comprisestaking an in-mouth impression with a resilient impression material afterthe immediate provisional implants are inserted; and shaping theprovisional dental prosthesis outside of the patient's mouth, based oninformation obtained from the in-mouth impression.
 18. A method forproviding a fixed, temporary dental prosthesis during a healing periodfor allowing osseointegration of two or more permanent implantsimplanted into the jaw bone of a patient, comprising: implanting one ormore provisional implants in the jaw bone at positions generally betweenthe permanent implants, each of the provisional implants includingabutment protruding out of the bone; temporarily attaching an extenderto one or more of the provisional implants to better display itsorientation; bending at least one of the one or more provisionalimplants with a bending tool; and adhering a temporary dental prosthesisto the abutments such that it is supported by the provisional implantsduring the healing period while substantially preventing masticationforces from being exerted on said permanent implants.
 19. The method ofclaim 18, further comprising removing the provisional implants after thehealing period.
 20. The method of claim 18, wherein each provisionalimplant has an implanted segment having a maximum width transverse to animplant axis less than a maximum width transverse to an implant axis ofthe permanent implants.
 21. The method of claim 20, wherein maximumwidth of the provisional implants is no more than about half the maximumwidth of the permanent implants.
 22. The method of claim 18, whereineach provisional about a site no less than about 3 mm from a permanentimplant site.
 23. The method of claim 18, further comprising installinga permanent dental prosthesis upon the permanent implants after removingthe temporary dental prosthesis.
 24. A system for providing an interimdental prosthesis while allowing healing and osseointegration of two ormore permanent implants anchored within a patient's mouth comprising:one or more provisional implants for anchoring generally adjacent thepermanent implants, each said provisional implant comprising a threadedbody segment having a maximum width of no more than about 3.5 mm, aflexible neck segment integrally formed with and extending from the bodysegment, the neck segment including a torque accepting feature, and anabutment integrally formed with and extending from the neck segment forreceiving a dental restoration; and a temporary dental restorationconfigured to be supported upon the provisional implants such that suchthat it is supported by the provisional implants during the healingperiod while substantially preventing mastication forces from beingexerted on said permanent implants.
 25. The system of claim 24, whereinthe provisional implants each include a threaded segment for engagementwith cortical bone.
 26. The system of claim 25, wherein the threadedsegments of each provisional implant is non-conically tapered.
 27. Thesystem of claim 25, wherein the threaded segment of each provisionalimplant is longer than threaded portions of each permanent implant. 28.The system of claim 25, wherein the provisional implants each furthercomprise an abutment extending integrally from the threaded segment atleast about 3.0 mm.
 29. The system of claim 28, wherein the abutmentextends integrally from the threaded segment at least about 6.0 mm. 30.A system for providing an immediate provisional dental implant,comprising: a plurality of provisional dental implants, each including athreaded body segment having a maximum width of no more than about 3.5mm, a neck segment integrally formed with and extending from the bodysegment, the neck segment including a torque accepting feature andhaving a bending portion sufficiently pliable to bend upon applicationof bending forces when the threaded body is anchored in the bone, and anabutment integrally formed with and extending from the neck segment; anosteotomy drill having a diameter less than the maximum width of thethreaded body; and a torque-supplying driver tool adapted to engage withthe torque-accepting feature of each provisional dental implant andimpart rotation for self-screwing the provisional implant into anosteotomy drilled by the osteotomy drill.
 31. The system of claim 30,wherein the torque-supplying driver tool comprises an insertion wrenchadapted to fit over the abutment and engage with the torque-acceptingfeature of each provisional dental implant.
 32. The system of claim 30,wherein the torque-accepting feature comprises a plurality of facetsextending circumferentially around the neck segment.
 33. The system ofclaim 30, further comprising a plurality of extenders, each adapted tobe temporarily mounted upon and parallel to the abutment of one of theprovisional implant.
 34. The system of claim 30, further comprising atorque-supplying retrieval tool adapted to remove each provisionalimplant from bone.
 35. The system of claim 30, further comprising abending tool configured to engage with the abutment of each provisionalimplant.
 36. The dental implant system of claim 30, further comprising aplurality of copings each configured to mate with and temporarily adhereto the abutment of one of the provisional implants.
 37. A dental implantsystem for treating a fully or partially edentulous patient, comprisinga plurality of permanent implants sized and adapted to be anchoredwithin cortical bone in the patient's mouth; and a plurality ofprovisional implants sized and adapted to be anchored within thecortical bone at positions generally adjacent or between the permanentimplants, each of the provisional implants being narrower than each ofthe permanent implants and comprising an integral abutment, a threadedsegment and a flexible neck that lies between the abutment and thethreaded section, whereby the provisional implants are adapted toreceive and support a temporary dental prosthesis during the healingperiod for the permanent implants while substantially preventingmastication forces from being exerted on the permanent implants.
 38. Thedental implant system of claim 37, wherein each of the provisionalimplants is configured to extend deeper into the cortical bone thanadjacent permanent implants.
 39. The dental implant system of claim 37,further comprising a temporary prosthesis adapted to be adhered to andsupported upon the provisional implants.
 40. The dental implant systemof claim 39, wherein the temporary prosthesis is adapted to be adheredto the integral abutment extending from the threaded segment of eachprovisional implant being submerged in the cortical bone.